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Objective To observe the promoting effect of pulsed shortwave therapy on wound healing in pediatric patients with upper limb burns and explore its underlying mechanisms. Methods A total of 40 children with deep Ⅱ° upper limb burns treated in our hospital from June 2021 to June 2023 were enrolled, and randomly divided into a control group and an observation group, with 20 cases in each group. The control group received conventional dressings, and the observation group received conventional dressings combined with pulsed shortwave therapy. The wound healing time, first appearance of skin islands on the wound, and initial number of skin islands were observed and recorded using a camera. The proportion of granulation tissue area in the wound was observed using eKare inSight 3D. The positive rate of wound bacteria was detected by collecting wound secretions for bacterial culture examination. Blood flow perfusion on the wound was measured using a blood flow meter. Results The observation group showed significantly faster wound healing and initial appearance of epithelialization (P < 0.05), and obviously higher rate of granulation tissue growth than the control group (P < 0.05). Moreover, the observation group demonstrated better control of bacterial infection in the wounds than the control group (P < 0.05). Blood flow measurement results revealed no significant increase in blood flow perfusion after pulsed shortwave therapy in the observation group (P>0.05). However, with the elapse of time, both groups exhibited an increasing trend in blood flow perfusion (P < 0.05). Conclusion Pulsed shortwave therapy effectively promotes wound healing in pediatric patients with burns, by facilitating necrotic tissue clearance and granulation tissue regeneration, which may be associated with its non-thermal effects.

Objective To observe the therapeutic effect of sonophoresis vitamin E on postinflammatory hyperpigmentation after facial second degree burn. Methods All the 36 patients with facial second degree treated in our hospital between September 2019 and September 2020 were recruited in this study. Twenty-four of them were randomly assigned into the observation group (n=12) and the control group (n=12), and the other 12 who refused treatment were automatically assigned to the blank control group (n=12). The observation group was treated with vitamin E (0.5~1 mL, twice per day) by sonophoresis (frequency 1 MHz, intensity 0.8 W/cm2, twice per day), while the control group was only treated with vitamin E, and the blank control group was not treated with vitamin E. And the 3 groups of patients followed strictly physical sunscreen for facial skin. After 2 and 4 weeks of treatment, the curative effects were observed and compared among the 3 groups. Results After 2 weeks, the total effective rate was 83.33% in the observation group, 66.67% in the control group, and 8.33% in the blank control group; And significant difference in the rate was observed among the 3 groups (P=0.001). In 4 weeks after treatment, the total effective rate was 83.33% in both the observation group and the control group, obviously higher than that of the blank control group (25.00%, P=0.011). The observation group obtained less pigment area and weaker pigment intensity when compared the other 2 groups in 2 and 4 weeks after treatment (P < 0.05), and the conditions in the pigmentation were better in the control group than the blank control group (P < 0.05). With time elapsing, the pigment area and pigment intensity were in a trend of decreasing in all of the 3 groups. The conditions after 4 weeks' treatment were greatly improved than those at 2 weeks in the control group (P < 0.05). Those at 2 weeks in the observation group were similar to those in the control group after 4 weeks' treatment (P>0.05). Conclusion Vitamin E though sonophoresis can effectively improve the postinflammatory hyperpigmentation and shorten the effective time for facial burn.

Objective To investigate the clinical effectiveness of stromal vascular fraction gel (SVF-gel) containing human adipose derived stem cells (ADSCs) in the treatment of adherent scar. Methods A retrospective analysis was carried out on the patients with adherent scars meeting our inclusion criteria and undergoing the treatment of gel injection during June 2018 and June 2020. The SVF-gel was prepared from the lipoaspirates sucked from the abdomen or the thigh followed by filtration, centrifugation and emulsion, and then injected into the adherent scars (at an interval of 2 mm for every needle puncture, SVF-gel 0.02 mL for every dose). Small amount of granular adipose tissues and SVF-gel were digested, cultured and identified. The scar hardness and thickness were measured for every patient preoperatively and 6 months postoperatively. Patient and observer scar assessment scale (POSAS) was used to evaluate scar condition, and patient satisfaction was investigated. Results There were 8 patients enrolled in this study, with a total of 10 adherent scars and the area of depression of 5.56±4.50 cm2. The injection volume of SVF-gel under the adherent scar was 3.90±3.00 mL. The results of morphological observation showed that short spindle cells grew in both SVF-gel and granular fat after digestion, and the over 95% obtained cells expressed the specific markers of mesenchymal stem cells, CD73, CD90 and CD105. At the same time, the number of primary cells cultured in same volume of SVF-gel was larger than the number from the granular fat tissue. Differentiation study found the growth of adipose-like cells in vitro, which were positive to oil red O staining. The scar hardness was decreased from 48.13±20.59 shore units preoperatively to 30.96±15.66 shore units in 6 months postoperatively(P < 0.05), and the scar skin thickness was increased from 2.00±0.60 mm to 2.72±0.63 mm (P < 0.05). In 6 months after operation, the appearance and activity of scar skin were significantly improved, and no complications were observed. The scores of patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS) were 12.0±2.8 and 13.7±3.9 respectively, and the patient satisfaction score was 4 to 5, with an average of 4.6. Conclusion Our prepared SVF-gel contains more active ADSCs. Its injection can improve the local depression and scar texture in the adherent scar and achieve good satisfaction in the patients.

Objective To explore the effect of low frequency electrical stimulation on chronic wound healing. Methods Forty-eight patients with chronic wounds who were treated in our hospital from September 2017 to September 2020 were enrolled in this study. The course of disease ranged from 31 to 65 d, and there were 15 cases of infectious ulcer, 27 cases of diabetic ulcer and 6 cases of connective tissue ulcer. All the patients were treated by following the principle of TIME (wound evaluation, infection control, maintenance of wet balance, promotion of wound edge epithelialization), and were randomly divided into the observation group and the control group. Besides the routine dressing change given to the both group, those from the observation group were treated with Dutch ultrasound electrotherapy workstation Myomed632VUX (frequency 100 Hz, wave rise ∶wave drop to 3 s ∶3 s, current intensity 15 mA) for 30 min, once a day, 5 times per week. The wound healing (eKare inSight 3D Wound Measurement), infection control and blood perfusion of the wound (PeriScan PIMⅡ Blood Perfusion Imager) before and after each low frequency electrical stimulation were compared between the 2 groups at 3, 7, 14 and 21 d after treatment. Results There were significant differences in wound healing between the 2 groups at different time points (P < 0.05). The chronic wound healing rate was as high as (87.59±5.81)% in the observation group in 14 d after treatment. Low frequency electrical stimulation resulted in well controlled infection in the observation group at 8.83±5.75 d, which was significantly earlier than that in the control group (12.41±9.52 d, P < 0.01). At each time of electrical stimulation, the amount of blood perfusion in the wound of the observation group was significantly larger than that in the control group, and continued to increase after being separated from electrical stimulation. And on the 3rd day, the blood perfusion of wound in the observation group was remarkably larger than that in the control group (287.22±13.14 vs 155.20±5.62 PU, P < 0.01), and the difference was increased gradually with the elapse of time (P < 0.01). Conclusion Low frequency electrical stimulation can promote chronic wound healing, shorten the time of wound infection control and increase wound blood perfusion.

Objective To investigate the causes of keloid invasive growth by comparing the expressional differences of E-cadherin, vimentin, vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-1 (HIF-1α), and the epidermal histological differences among keloid marginal region, central region and normal skin. Methods This study enrolled 16 patients undergoing keloid resection in our department from October 2019 to August 2020, with a total of 16 keloid tissues, and 9 patients who required partial normal skin resection during the operation, with a total of 9 normal skin tissues. Hematoxylin and eosin (H&E) staining was used to observe the tissue morphology, and immunohistochemical staining and Western blot assay were used to detect the expression of E-cadherin, vimentin, VEGF and HIF-1α in above tissues. Results There was obvious abnormality and heterogeneity in the epidermal layer of keloids. The marginal epidermal subdivided into fine-branch-like and then clearly penetrated into the dermis, forming a houndstooth-like appearance, while the central epidermal became thick and flat; Immunohistochemical staining and Western blot assay showed that the expression level of E-cadherin was significantly weaker in the marginal and central epidermal of keloid tissue than in the normal skin (P < 0.05), with that in the margin weaker than the center (P < 0.05); The levels of vimentin, HIF-1α and VEGF were significantly higher in the keloid tissue than normal skin (P < 0.05), and those in the margin took the highest (P < 0.05). Conclusion Marginal epidermis of keloid clearly extends to the dermis in branched appearance, with active epithelium-to-mesenchymal transition (EMT), highly expressed HIF-1α, VEGF and abundant microvessels. The underlying mechanism may be related to the aggressive growth of the keloid edge, and HIF-1α might be the key factor.

Objective To observe and summarize the differences in ultrasonic characteristics, scar thickness and echo intensity for different types of scar skins by using 20 MHz high-frequency ultrasound. Methods A total of 48 patients with scars admitted to our hospital from 2018 to 2019 were recruited in this study, and were divided into hypertrophic scar group (n=20), keloid scar group (n=18) and atrophic scar group (n=10) according to scar categories. Another 20 volunteers with normal skin living in Luzhou urban area served as normal control group. Ultrasound images of scar skin or normal skin of volunteers were collected by 20 MHz high-frequency ultrasound. Skin thickness was measured by distance measuring tool of this software. At the same time, echo density was analyzed by DFY-Ⅰ ultrasound image quantitative analysis. Results In terms of the structure of skin tissue, compared with normal skin, hypertrophic scar and keloid had uneven epidermis and upward protuberance, and clear boundary between dermis and subcutaneous tissues. Atrophic scar skin had a thin epidermis and the unclear boundary between dermis and subcutaneous tissue. In terms of overall skin thickness, the skin thickness of hypertrophic scar (P < 0.001) and keloid(P=0.001) was significantly thicker than that of atrophic scar and normal skin, while there was no significant difference between atrophic scar and normal skin. In terms of echo density, the echo density of hypertrophic scar(P=0.001) and keloid(P < 0.001) dermis was significantly lower than that of normal skin. Hypertrophic scars appeared as striated hypoechoic areas in the upper dermis, while keloids as oval hypoechoic areas concentrated under the epidermis.There was no significant difference in overall echo density between atrophic scar and normal dermis. Conclusion The 20 MHz high-frequency ultrasound shows the characteristic ultrasonic manifestations of different types of scar.The dermis of keloid has a concentrated oval hypoechoic region, while the dermis of hypertrophic scar has a low gyrus.However, the boundary of each skin in atrophic scar sublayer is unclear, which the dermal echo intensity is uneven.

It was aim to study the physicochemical features and biocompatibility of electrospun collagen-chitosan membranes, and its potential in guided bone regeneration. Electrospinning technology was applied in the fabrication of electrospun collagen membranes and electrospun collagen-chitosan membranes following observation of scanning electron microscope. Physicochemical properties including tensile strength, elongation rate, porosity, degradation rate, and biocompatibility of membranes were measured then. In vivo, calvarial bone defects created on rats were covered with two kinds of membranes respectively. In the 4th and 8th week, enzyme-linked immunosorbent assay testing bone alkaline phosphatase and osteocalcin, Micro CT analyzing bone volume, bone volume/total volume, trabecular number and trabecular spacing values, and histological staining were carried out for evaluating the potentials of the membranes on bone regeneration. We found that regular and highly-porous structure favoring the adhesion and proliferation of periodontal ligament cells was observed in all electrospinning groups. Compared with electrospun collagen membranes, electrospun collagen-chitosan membranes performed better physiochemical features including higher tensile strength and more stable degradation rate. In the animal model, compared with the other groups, higher levels of bone alkaline phosphatase in the 4th week and osteocalcin in the 8th week were observed in the electrospun collagen-chitosan membrane. Meanwhile, both of the radiographical and histological results further confirmed that the new bone formation (with higher bone volume, bone volume/total volume, Trabecular number, and lower Trabecular spacing) were more active in the electrospun collagen-chitosan membrane. In conclusion, Electrospun collagen-chitosan membranes perform excellent physicochemical properties, biocompatibility, and great effects on guided bone regeneration, which as the membrane has good application prospect in tissue regeneration. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the maternal and infant oral health benefits from mothers receiving prenatal total oral rehabilitation (PTOR) before childbirth., Methods: Building upon our previous investigation, in which 15 expectant mothers received PTOR before their third trimester, achieving a state of oral health free from disease prior to delivery, we conducted a follow-up study to monitor these mothers and their newborns until they reached 2 years of age. We assessed the impact of PTOR on maternal and infant oral health, the utilization of dental care during the postpartum/early-life period, and the carriage of oral cariogenic microorganisms among mothers and their infants. Control groups consisting of 11 children and 17 mothers who did not undergo PTOR were included for comparative analysis., Results: PTOR demonstrated a sustained improvement in maternal oral health outcomes by the end of 2 years postpartum, evidenced by a reduction in the Plaque Index and decayed surfaces compared with the control group ( p  < 0.05). PTOR was also associated with increased perinatal oral health literacy compared with the baseline of the mothers themselves ( p  < 0.05). In addition, PTOR led to a notable increase in maternal dental care utilization, rising from 26.7% before PTOR to 80% at 1 year postpartum and 70% at 2 years postpartum. Intriguingly, 40% of infants in the PTOR group had their first dental visit before reaching 1 year of age, in contrast to national data from the USA indicating a rate of less than 1%. Furthermore, a decrease in plaque Streptococcus mutans was observed in PTOR mothers 2 years postpartum, compared with both their baseline carriage and that of the control group ( p  < 0.05). Infants in the PTOR group also had a lower incidence of early childhood caries, with 18% in the PTOR group vs. 27% in the control group, although this difference was not statistically significant due to the small sample size., Conclusions: PTOR is associated with sustained oral health benefits and improves dental care utilization by mothers and their infants. Large-scale clinical trials are warranted to validate these study findings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Yang, Rashwan, Al Jallad, Wu, Lu, Wu and Xiao.)

Objective: To investigate the effectiveness of free anterolateral thigh flap (ALTF) with fascia lata in repairing diabetic foot ulcers (DFUs) with bone exposure., Methods: Between January 2019 and January 2021, 20 patients with DFUs with bone exposure were admitted. There were 17 males and 3 females with a median age of 57.5 years (range, 48-76 years). There were 10 cases of Wagner grade 3 and 10 cases of grade 4. The DFUs formed 1 to 14 months, with a median time of 3 months. The patients underwent CT angiography, which showed extensive atherosclerosis in both lower limbs; 6 of them were severely narrowed or occluded and underwent percutaneous transluminal angioplasty. The size of wound ranged from 7 cm×6 cm to 27 cm×10 cm after applied first-stage debridement combined with vacuum sealing drainage treatment. In the second-stage, free ALTF with fascia lata was used to repair wounds and partial defects of tendons. The size of flap ranged from 8 cm×5 cm to 28 cm×11 cm. The wound of the donor site was sutured directly. The survival of the flap, the healing time of the wound, and the complications were recorded. The laser speckle blood flow imaging system was used to detect the blood perfusion of the flap and the skin around the flap at 2 weeks and 6 months after operation. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 months after operation., Results: After operation, effusion under the flap happened in 6 cases, which cured after symptomatic treatment. Flaps survived completely in 14 cases. The tissue necrosis at the edges of the flaps occurred in 3 cases and healed after dressing changes. Venous crisis of flaps occurred in 3 cases, of which 1 case was completely necrotic after exploration, and the other 2 cases were partially alive. The wounds of 3 cases were repaired with skin grafts after debridement and dressing. The flap survival rate was 95.0%, and the limb salvage rate was 100%. The wound healing time after flap transplantation was 14-30 days, with an average of 19.1 days. Two patients had recurrence of peripheral skin ulcers of the flaps within 1 month after healing, which healed after conservative dressing changes. Eighteen cases of incisions at donor site healed by first intention, 2 cases had local skin necrosis and healed by debridement and suture. All patients were followed up 6-30 months, with a median time of 11 months. The texture, appearance, and elasticity of the flaps were good. All patients could walk alone without pain. At 6 months after operation, the AOFAS score was 75.9±11.9, which was significantly different from that (44.7±18.4) before operation ( t =-7.025, P =0.000). The blood perfusion value increased from (38.1±7.8) PU at 2 weeks to (42.7±10.3) PU, and the difference was significant ( t =-4.680, P =0.001)., Conclusion: Free ALTF with fascia lata has a rich blood supply and a high survival rate. It can be used to repair DFUs with bone exposure. After the free skin flap healed, it can promote revascularization of the affected foot, reduce the probability of ulcer recurrence, and avoid amputation.

It was aim to study the physicochemical features and biocompatibility of electrospun collagen-chitosan membranes, and its potential in guided bone regeneration. Electrospinning technology was applied in the fabrication of electrospun collagen membranes and electrospun collagen-chitosan membranes following observation of scanning electron microscope. Physicochemical properties including tensile strength, elongation rate, porosity, degradation rate, and biocompatibility of membranes were measured then. In vivo , calvarial bone defects created on rats were covered with two kinds of membranes respectively. In the 4th and 8th week, enzyme-linked immunosorbent assay testing bone alkaline phosphatase and osteocalcin, Micro CT analyzing bone volume, bone volume/total volume, trabecular number and trabecular spacing values, and histological staining were carried out for evaluating the potentials of the membranes on bone regeneration. We found that regular and highly-porous structure favoring the adhesion and proliferation of periodontal ligament cells was observed in all electrospinning groups. Compared with electrospun collagen membranes, electrospun collagen-chitosan membranes performed better physiochemical features including higher tensile strength and more stable degradation rate. In the animal model, compared with the other groups, higher levels of bone alkaline phosphatase in the 4th week and osteocalcin in the 8th week were observed in the electrospun collagen-chitosan membrane. Meanwhile, both of the radiographical and histological results further confirmed that the new bone formation (with higher bone volume, bone volume/total volume, Trabecular number, and lower Trabecular spacing) were more active in the electrospun collagen-chitosan membrane. In conclusion, Electrospun collagen-chitosan membranes perform excellent physicochemical properties, biocompatibility, and great effects on guided bone regeneration, which as the membrane has good application prospect in tissue regeneration.